When asked by Department of Health advisers in 2005 to describe the future of primary care, the National Health Service Alliance and Small Practices Association suggested two models.1 The first consisted of nested practices on a purpose built site providing conventional general practice services, extended primary care services, and some that are currently provided within secondary care. The second model—the virtual super surgery—envisaged practices working from their current premises but having extended primary care and diagnostic facilities either within the practices or in a central “resource and treatment” centre. This is similar to the federated practices model described last year in a report by the Royal College of General Practitioners.2

Both models are in line with government thinking on polyclinics. They provide the basis for some much needed integration between general practice, community, and secondary care services, …